From the Trenches - 5/1

Quiet and Questions
Today was the quietest day of the week. People were still asking questions, but the worry in their eyes was a little bit less. A little.

The box of masks promised me yesterday was on my desk today. My nurse got back from a trip to Arizona; she said everyone was nervously looking at someone on the plane who was coughing. Nobody was wearing a mask, though.

I did a couple of flu tests - both negative. I did bot more to quell fears than anything. Patients wanted their coworkers and/or parents to know it was OK. There were a bunch of visits after which I stated, "This isn't Swine Flu." This was usually met with a grin, not a sigh, but some people looked relieved.

I met up with some skeptics - both in the office and online. Is this worth getting panicked about? Is it worth all the press coverage?

I have to say, I find myself wondering this myself. But my experience as a doctor teaches me that it is far better to overreact to something than to not take it seriously enough. I have this with patients coming into the office all the time. They have pain in their chest that they think is nothing, but they come in to be on the safe side. When I tell them I don't think it is their heart, they get all embarassed and apologize for "wasting my time." I immediately reassure them that they shouldn't be embarrassed. The best-case is that they came in and it was nothing serious. The worst-case is that they sat at home while they were having a heart attack.

The same thing is true with the flu. If we get all worked-up about the flu and it ends up being something that is not serious, I will be very happy. The world will be spared a big tragedy. But if we take this threat lightly and it ends up being a virus as deadly as some previous pandemic viruses, a lot of life will be lost because of our fear of overreaction.

But is the flu worth worrying about? There haven't been many deaths due to it so far - at least in the US. So why should we get worked up about it? Here is the rationalle for a strong reaction:

This is a virus against which nobody is immunized.

The fact that it was a pig virus that mutated means that it is significantly different from other flu viruses our bodies have been exposed to in the past. This is the reason pandemics are so deadly - the body takes longer to build up defenses and fight off the virus because it is basically new to the person.

The type of influenza - Influenza A, is a more virulent strain in general than Influenza B.

Even if this virus is an "average" or a "mild" influenza virus, the death tolls could still be quite high without aggressive action. Each year there are over 40,000 deaths in the US attributable to influenza (1) - and this is in a population that has a significant percentage of immunized people.

The H1N1 strain of this virus is the same strain found in the 1918 Spanish flu virus that cause the worst pandemic on record. 20 to 100 million people died of that pandemic - a large proportion of which were younger, more healthy individuals, not the people who typically succumb to flu each year. (2)

No, it doesn't seem that this virus is as virulant as the 1918 strain, but early indications in Mexico was that the death rate was quite high. The decision to exercise caution and act as if this would be similar to the Spanish flu virus is wise. Delay could result in the unnecessary deaths of thousands, even millions of people.

I am not being sarcastic at all when I react to this with caution (I know my readers are used to a bit of that). Statements by authorities of an "immenent pandemic" (3) sure as heck make me nervous. Maybe this is an overstatement. I sure hope it is. If so, I don't think it would be correct to call it a "mistake."

The best case scenario is that the threat is over-blown. Prepare for the worst and pray for the best.